Mammography screening significantly reduces breast cancer mortality

“The results of the study are very important because the previous recommendations on mammography screening were based on studies from the 1970s and 1980s. Since then, both diagnostic procedures and the treatment of breast cancer have improved significantly. It was therefore necessary to re-examine the benefits of mammography screening under today's conditions,“ explains Prof. Dr. Ulrike Haug, head of the Department of Clinical Epidemiology and deputy director of the BIPS. ”Our results confirm that participation in mammography screening significantly reduces the risk of dying from breast cancer. Thanks to the use of modern methods of causal inference, the results are very robust. On the one hand, we were able to avoid bias due to the study design. On the other hand, we were able to ensure that the different risk profiles between participants and non-participants were adequately taken into account. Comprehensive accompanying analyses confirmed the robustness of our results. To date, there is no other observational study worldwide that has evaluated mammography screening so rigorously and methodologically sound.“

She adds: ”Health insurance data with a long observation period is essential for the feasibility of this type of study. That is why the data from four statutory health insurance companies maintained by BIPS played a central role. This high-quality database was even supplemented for the study with data from BARMER, which was evaluated at the University of Bremen. This enabled us to cover a total of 37 percent of women of eligible age in Germany in the health insurance fund-based approach. The study impressively demonstrates the potential of health insurance fund data for evaluating preventive measures, provided that it is available over long periods of time.”

In addition to the health insurance fund-based approach, for which BIPS was responsible, there was also a population-based approach, which was evaluated by the University of Münster. Although this is limited to North Rhine-Westphalia, it covers all women who were eligible to participate in the mammography screening program there during the study period. Data from the North Rhine-Westphalia State Cancer Registry and the State Statistical Office were used for this purpose. The two complementary approaches were thus very different, but came to the same conclusion, namely that screening reduces breast cancer mortality by 20 to 30 percent. This agreement despite the different data sources and methods further confirms that the results are very reliable.

“We were tasked with evaluating whether mammography screening is beneficial under current conditions,” says Haug, summarizing the results. “Proving the benefits is crucial, because screening always has disadvantages, such as possible overdiagnosis or, in the case of mammography, radiation exposure. These aspects were not part of our study but have already been evaluated elsewhere. Our findings now confirm that nothing has changed in terms of benefits and that mammography screening remains a recommended measure for reducing breast cancer mortality.”

Participation reduces the risk of death

Breast cancer is the most common cancer among women. One in eight women in Germany will develop the disease during their lifetime. For 18,500 women per year, the disease is fatal. International studies had suggested that a mammography screening program for women aged 50 to 69 could prevent some breast cancer deaths, but these studies were conducted a long time ago and under different conditions.

The study, coordinated by the Federal Office for Radiation Protection and conducted by the University of Münster, examined how much the German mammography screening program actually reduces breast cancer mortality. The results confirm that mammography screening continues to offer significant benefits even under today's conditions: Compared to women who did not participate in screening, 20 to 30 percent fewer women who participated in screening died of breast cancer. This means that approximately one in four deaths could be prevented through early diagnosis.

The mammography screening program

The mammography screening program is the first systematic cancer screening program in Germany to meet European quality standards and the largest screening program in Europe. Women of eligible age receive a written invitation to undergo mammography. Participation is voluntary. Those who decide to participate can have the examination performed at one of 95 certified screening centers. The program is aimed at women who do not have any symptoms. Women with symptoms or a history of breast cancer receive the necessary examinations as part of regular health care.

Early detection with X-rays only with approval

X-ray examinations for the early detection of diseases are only permitted on apparently healthy, i.e., symptom-free individuals if the examination has been approved by the Federal Ministry for the Environment. The prerequisite is that the benefits clearly outweigh the radiation risk associated with the examination. This assessment was positive in the early 2000s for a mammography screening program for women aged 50 to 69. Since 2018, the Federal Office for Radiation Protection has been responsible for the risk-benefit assessment.

About the study

The study, which consists of four consecutive research projects, was coordinated by the Federal Office for Radiation Protection. The actual research was carried out by the University of Münster in collaboration with the North Rhine-Westphalia State Cancer Registry, the Leibniz Institute for Prevention Research and Epidemiology (BIPS) in Bremen, and the SOCIUM Research Center on Inequality and Social Policy at the University of Bremen.

The Federal Ministry for the Environment, the Federal Ministry of Health, and the Mammography Cooperation Group jointly covered the costs of around 10 million euros. A steering committee, advised by an independent scientific advisory board, decided on the basic content of the research project.

The comprehensive report (500 pages) with a detailed description of the methods and results of the study “Evaluation of breast cancer mortality in the German mammography screening program” is available in the Digital Online Repository and Information System DORIS under the URN nbn-resolving.org/urn:nbn:de:0221-2025062052653.

BIPS – Health research for the benefit of people

The population is at the center of our research. As an epidemiological research institute, we see our task as identifying health risks and developing concepts for disease prevention. Our research provides a basis for social decisions. It informs the population about health risks and contributes to a healthy living environment.

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Press contact

Rasmus Cloes, M.Sc.

Head of Transfer and Communication – Press Officer

Tel: 0421 21856780

Email: cloes(at)leibniz-bips.de